Paging Dr. Kafka

06.09.14

57,000 Vets Still Waiting for VA Care

The scandal that took down the VA secretary shows no signs of slowing.

Right now, there are more than 57,000 veterans who’ve been waiting at least 90 days for their first visit with a VA doctor. That’s according to a report released Monday. And it means the VA scandal that already took down its secretary is still growing.

The latest rundown of the VA’s woes is more comprehensive than the recent Inspector General’s report, focused on the VA’s troubled hospital in Phoenix. The new document presents an even more daunting set of problems. It comes out of an audit conducted by the VA itself that included site visits at medical facilities across the country and interviews with more than 3,500 VA employees.

Over the past decade, another 64,000 veterans enrolled in the VA system and requested medical appointments but never received them. Contacting each of those patients and getting them their overdue medical care is now the VA’s top priority, according to acting Secretary Sloan Gibson, who took the VA’s top post after Eric Shinseki’s resignation. To that end, Gibson said Monday, the VA had already reached out to 50,000 veterans to move them off of waiting lists and into appointments and was working to contact another 40,000. The problems identified in the VA’s report “demand immediate action,” Gibson said.

In addition to uncovering ten of thousands of veterans who now need to be scheduled in an already taxed system, the report also underscored the point, reported by The Daily Beast, that VA supervisors coached scheduling clerks to falsify wait times. Thirteen percent of VA schedulers contacted in the audit said they had been directed by their superiors to cheat the scheduling system. Another 8 percent of schedulers admitted using secret lists to track veteran’s appointments that kept wait times off the books. Overall, some evidence of scheduling fraud was found in 76 percent of the 731 VA facilities reviewed for the audit.

It took the VA a long time to acknowledge that widespread reports of records manipulation and lengthy patient delays were more than just “isolated incidents” but outbreaks of a systemic problem. Now, on paper at least, the VA is going further and confronting the root causes—both structural and cultural—of its systemic issues. Those issues, according to the report, include: staffing shortages, outdated scheduling software, inadequate training, and an institutional “culture which allowed this state of practice to take root,” and “must be confronted head on.”

But that analysis doesn’t go far enough, according to Army veteran and former high-ranking Pentagon staffer Phillip Carter.

“The manipulation of waiting lists masked a much larger problem with the allocation of clinical resources to veterans,” Carter said.

“The VA must dig deeper,” according to Carter, “to see clearly the resourcing issues that lie at the heart of this problem, and answer basic questions like whether the VA has sufficient resources, whether the VA spends those resources in the right places, whether the VA has sufficient numbers of medical personnel, and what wait times are achievable given what the VA has on hand. Carter added, “The VA must move quickly to answer these key questions, which in many ways are more important than assessing blame for what did or didn’t happen in Phoenix,” the hospital where the VA scandal first skyrocketed to national attention.

The VA said in a statement released Monday that it was already meeting Gibson’s call for immediate action. Among the measures outlined in the statement were: removing the current 14-day scheduling goal, which was deemed unrealistic; hiring additional staff to deal with the patient backlog; deploying mobile medical units to areas with a shortage of providers; and increasing transparency by posting data on wait times twice a month.

The underlying causes of the wait lists identified in the report don’t represent a new analysis—The Daily Beast and others have been pointing to them for weeks—but they are the first time VA itself has formally diagnosed its own maladies. And while Carter fairly points out that the VA won’t achieve a long-term solution without a frank analysis of its ability to meet its current demands, it has removed some of the immediate drivers of the current crisis. Cancelling senior executives’ performance bonuses, which have been repeatedly cited by VA employees as a primary cause of scheduling manipulation, won’t fix the VA’s deeper issues but is a step toward accountability.